Principles of Integrated Cognitive Training for Executive Attention: Application to an Instrumental Skill

Abstract

One effective cognitive treatment is the rehabilitation of working memory (WM) using an integrated approach that targets the "executive attention" system. Recent neuroscientific literature has revealed that treatment efficacy depends on the presence of various features, such as adaptivity, empathy, customization, avoidance of automatism and stereotypies, and alertness activation. Over the last two decades, an Integrated Cognitive Training (ICT) protocol has been proposed and developed; ICT takes the above-mentioned features and existing literature into account, and has been used to promote the development of reading skills. ICT has been employed in several clinical settings and involves stimulation of a specific deteriorated system (e.g., reading) and the improvement of executive attention components, thus also increasing working memory capacity. In this context, we present two experiments. In Experiment 1, participants diagnosed with dyslexia (aged between 8 and 14 years) underwent two ICT sessions a week, with home supplements, for a duration of 7 months. The participants showed a significant improvement in the reading speed of text, words, and non-words, and in the reading accuracy of text and non-words. In Experiment 2, we replicated Experiment 1, but included a comparison between two groups (experimental group vs. control group) of young participants with diagnosis of dyslexia. The experimental group was subjected to 18 ICT sessions twice a week and with home supplements, using the same protocol as in Experiment 1. The control group was entrusted to the protocol of compensatory tools and dispense/helping procedures provided by the scholastic Personalized Educational Plan. After training, the experimental group gained about 0.5 syllables per second in text reading, and a marked decrease in error rate. The control group showed no significant improvement in reading skills after the same period. Moreover, the improvement observed in the experimental group remained stable 4 months after ICT had ended. The results of these two experiments support the efficacy of the integrated ICT protocol in improving reading skills in children with dyslexia and its sustained effect.

Keywords: adaptive treatment; cognitive training; dyslexia; executive attention; working memory capacity.

Figure 1

Significant increases in speed (text, words, and non-words) and accuracy (text and non-words) of reading. Statistical differences are marked according to the p-values at both Wilcoxon test and t-test on Z scores. The change in text reading speed was 494.4% higher than expected (+1.08 syll/s; see Discussion).

Figure 2

Within and between group analyses show significant increases in speed (text and non-words) and accuracy (text and non-words) of reading in the Experimental group, from T0 to T1. Statistical differences are marked according to the p-values at Wilcoxon test on Z scores. The change in speed text was 607% higher than expected in the experimental group.

Figure 3

Experimental group, within subjects comparisons. Significant increase in text speed and accuracy from T0 to T1 and from T0 to T2 and in non-words speed from T0 to T1 and from T0 to T2 (Tables 5, 7). Statistical differences are marked according to the p-values at Wilcoxon test on Z scores. No significant change of the improvement obtained in T1, compared to the measures at T2 (all p > 0.05).